Misdiagnosis of attention deficit hyperactivity disorder: ‘Normal behaviour’ and relative maturity

Attention deficit hyperactivity disorder (ADHD) is one of the most frequently diagnosed disorders in children, yet it remains poorly understood. Substantial controversy exists regarding correct diagnosis of ADHD, and areas of subjectivity in diagnosis have been identified. Concerns for appropriate diagnosis are critical in terms of children’s educational outcomes, as well as health concerns associated with the use and potential overuse of stimulant medications. There exists a relative-age effect in which children who are relatively younger than their peers and born closest to the school start age cut-off are more frequently diagnosed and treated for ADHD. Additionally, substantial variation exists in ADHD diagnosis between boys and girls, with boys often presenting with more stereotypical symptoms. Both the relative-age effect and variation in sex diagnosis, as well as the challenges of early preschool diagnosis, emphasize the importance of considering relative maturity in ADHD diagnosis of children. Implications and knowledge translation strategies for practitioners, parents and the education system are presented.     

互联互通标准化成熟度测评对医院信息平台建设的指导和规范作用

针对目前国内医院信息平台建设的难点,探讨如何应用国家卫生标准委员会颁布的《医院信息互联互通成熟度测评方案》,指导医院信息平台建设。按照医院信息互联互通成熟度测评方案中四级甲等的标准,从数据集标准化、共享文档规范化、技术架构、互联互通服务、运行性能、基础设施6个方面,指引和规范医院信息平台建设的规划、实施和验收。     

Morbilidad neonatal en los recién nacidos a término precoz

IntroductionIn the last decades has increased significantly The birth of children from 37 to 38 weeks of gestation, a period called early term, has significantly increased in the past twenty years or so, parallel to the increase in induced deliveries and the cesarean rate.Patients and methodRetrospective cohorts population study, which included those babies born between 37 and 41 weeks of gestation in the period 1992-2011 (n = 35.539). This population was divided into two cohorts, early term newborn (RNTP) of 37-38 weeks (n = 11,318), and full term newborn (RNTC), of 39-41 weeks of gestation (n = 24,221). The rates of cesarean section, neonatal unit admission, respiratory morbidity, apnea and need for assisted ventilation, hyperbilirubinemia requiring phototherapy, hypoglycemia, seizures, hypoxic-ischemia encephalopathy, need for parenteral nutrition and early sepsis were all reviewed.ResultsThere was a progressive increase in the number of caesarean sections throughout the period studied (from 30.9% to 40.3%). The cesarean section rate was higher in RNTP than in the RNTC (38.3% vs 31.3%, P<.0001). On comparing the two groups, significant differences were found in the rate of admission to neonatal unit, 9.1% vs 3.5% (P<.0001); respiratory morbidity (hyaline membrane 0.14% vs 0.007% [P<.0001], transient tachypnea 1.71% vs 0.45% [P<.0001], mechanical ventilation 0.2% vs 0.07% [P<.009], continuous positive airway pressure 0.11% vs 0.01% [P<.0001]), phototherapy 0.29% vs 0.07% (P<.0001), hypoglycemia 0.54% vs 0.11% (P<.0001), parenteral nutrition 0.16% vs 0.04% (P<.0001). There were no significant differences in the rate of early sepsis, pneumothorax, aspiration syndromes, seizures and hypoxic-ischemic encephalopathy.ConclusionsIn our environment, there is a significant number of RNTP, which have a significantly higher morbidity than newborns RNTC registered. After individualizing each case, it is essential not end a pregnancy before 39 weeks of gestation, except for maternal, placental or fetal conditions indicating that continuing the pregnancy may increase the risk for the fetus and/or the mother.     

Dental maturity in children of short stature, with or without growth hormone deficiency

The aim of this investigation was to study dental maturity in healthy prepubertal children of short stature (height < −2 SD), with or without growth hormone (GH) deficiency, compared to healthy controls. The GH-deficient group (GH level < 10.0 μg/l) included 29 children (11 female. 18 male) with a mean age of 10.2 ± 2.2 years. The GH non-deficient group consisted of 17 children (5 female. 12 male) with a mean age of 8.5 ± 2.1 years. All the children were evaluated for serum concentrations of IGF-1, alkaline phosphatase (ALP), triiodthyronin (T3), thyroxine (T4). thyroid-stimulating hormone (TSH). and fasting plasma insulin: height and bone age were also recorded. Dental maturity was determined from panoramic radiographs. The mean difference between the dental and chronological ages was −0.67 ± 0.89 years in the GH-deficient group compared to 0.23 ± 1.07 years in their controls: in the GH non-deficient group the difference was −0.95 ± 0.82 years compared to controls 0.16 ± 1.06 years in their controls. Compared to chronological age. both bone and dental age were lower in the GH-deficient and GH non-deficient groups. It is concluded that children of short stature, both GH-deficient and GH non-deficient, exhibit a delayed dental age compared to their chronological age- and sex-matched controls. A multiple stepwise regression analysts showed that the sitting height and GH level were the only significant factors associated with dental maturity.     

Defining a standard and weighted mathematical index for maturation of dendritic cells

The concept of dendritic cell (DC) maturation generally refers to the changes in morphology and function of DCs. Conventionally, DC maturity is based on three criteria: loss of endocytic ability, gain of high‐level capacity to present antigens and induce proliferation of T cells, and mobility of DCs toward high concentrations of CCL19. Impairment of DC maturation has been suggested as the main reason for infectivity or chronicity of several infectious agents. In the case of hepatitis C virus, this has been a matter of controversy for the last two decades. However, insufficient attention has been paid to the method of ex vivo maturation as the possible source of such controversies. We previously reported striking differences between DCs matured with different methods, so we propose the use of a standard quantitative index to determine the level of maturity in DCs as an approach to compare results from different studies. We designed and formulated a mathematically calculated index to numerically define the level of maturity based on experimental data from ex vivo assays. This introduces a standard maturation index (SMI) and weighted maturation index (WMI) based on strictly standardized mean differences between different methods of generating mature DCs. By calculating an SMI and a WMI, numerical values were assigned to the level of maturity achieved by DCs matured with different methods. SMI and WMI could be used as a standard tool to compare diversely generated mature DCs and so better interpret outcomes of ex vivo and in vivo studies with mature DCs.     

成熟度对江西单叶蔓荆子质量的影响

目的:比较不同成熟度单叶蔓荆子中挥发性成分、总黄酮及蔓荆子黄素含量的差异。方法:采用气相色谱-质谱联用技术(GC-MS)分离鉴定蔓荆子中挥发性成分,利用峰面积归一化法计算各成分的相对质量分数,结合紫外分光光度法和HPLC分别测定蔓荆子中总黄酮和蔓荆子黄素的含量。结果:厚田黄果和黑果分别鉴定了35,36种化合物,二者相同成分有30种;都昌黄果和黑果分别鉴定了31,27种化合物,两者相同成分有23种。不同成熟度蔓荆子挥发油成分种类相似,但各成分的含量却存在很大差异。厚田黄果、厚田黑果、都昌黄果及都昌黑果中蔓荆子黄素质量分数分别为0.268%,0.209%,0.226%,0.242%,总黄酮质量分数依次为7.902%,3.540%,3.982%,2.617%。结论:不同样品中总黄酮含量存在很大差异,黄果与黑果中蔓荆子黄素的含量不存在显著性差异。成熟度对蔓荆子的品质影响很大。     

糖皮质激素促肺成熟作用的研究进展

大量研究证实围生期使用糖皮质激素可促进肺成熟,显著降低新生儿呼吸窘迫综合征的发病率和病死率.其作用机制主要是促进肺泡发育和肺表面活性物质系统的成熟.同时,围生期使用糖皮质激素对胎儿和新生儿造成的不良影响正受到越来越多的关注.产前重复使用糖皮质激素和生后早期静脉使用糖皮质激素的安全性仍不确定.糖皮质激素的给药途径、不同剂量糖皮质激素的作用效果和机制仍需深入研究.该文对近年来产前使用糖皮质激素和新生儿早期使用糖皮质激素促肺成熟作用的临床研究和动物实验研究进行综述.     

Adolescent idiopathic scoliosis: a review of current concepts

Adolescent idiopathic scoliosis is a common condition which is routinely seen in the outpatient department, with a prevalence of 5% in general population. It is important to be able to make this diagnosis but more importantly exclude other causes of scoliosis by carrying out a thorough history and examination. This paper will cover the pathophysiology, presentation, examination, and surgical management of adolescent idiopathic scoliosis.     

Pharmacotherapy for the treatment of vaginal atrophy

Introduction: Despite its frequency, recognition and therapy of vulvovaginal atrophy (VVA) remain suboptimal. Wet mount microscopy, or vaginal pH as a proxy, allows VVA diagnosis in menopause, but also in young contraception users, after breast cancer, or postpartum. Intravaginal low dose estrogen product is the main therapy. Ultra-low-dose vaginal estriol is safe and sufficient in most cases, even in breast cancer patients, while hyaluronic acid can help women who cannot or do not want to use hormones.

Areas covered: The authors provide an overview of the current pharmaceutical treatment for vulvovaginal atrophy and provide their expert opinions on its future treatment.

Expert opinion: The basis of good treatment is a correct and complete diagnosis, using a microscope to study the maturity index of the vaginal fluid. Minimal dose of estriol intravaginally with or without lactobacilli is elegant, cheap and can safely be used after breast cancer and history of thromboembolic disease. Laser therapy requires validation and safety data, as is can potentially cause vaginal fibrosis and stenosis, and safer and cheaper alternatives are available.